Working with overweight + depressed clients.

As a little background- I recently took on a client that had lapband surgery. She lost 80lbs and reached a healthy weight, but after a few months of following her old diet broke the band and regained the weight.

She is extremely disgruntled, and does not show progress in the gym because she does not want to put in effort. She has a hard time standing up due to her weight, and I cannot have her do anything in front of a mirror- If you didnt notice, most gyms are 60% mirror.

TL;DNR

How do you motivate someone who would purchase 6 months of work, but rather not come in after 2 weeks. Literally gives you money but doesn't want to use it.

Answers (12)

"Don't be upset by the results you didn't get by the work you didn't do" is my newest favorite quote.
I think our medical world is doing us a great injustice with lap-band surgery. This is another attempt at making money for a quick fix that is risky and at times, like this client, it does not work.

To me, the underlying factor of her distress started way before her lap band procedure. Behavior doesn't change just because her stomach is smaller.

I would suggest that she see's a professional therapist who deals with these issues. Her surgeon should have had her do this prior to the surgery, I believe most do.

She has to re start her process and yes it will be difficult if her mindset is where you say it is.

As her trainer the best thing you can do is stay within your professional scope and not force her but be supportive and understanding because ultimately it's up to her.

Hello Bryant,
I think you have your hands full on with this client.
Personally I would not take this client based on her past behavior regardless of the finacial gain. I would also suggest she consult a therapist and her physician.

If she consults a therapist/physician and shows progress with her weight and behavior, then I would consider her as a client. Her long term health, nutrition and behavior should be the highest priority.

Stay in touch with her and support her until she regains control with her personal issues. Keep us posted with her progress.

I am sorry to hear about your client and I can only imagine what she is going through.

While there is some truth in Susan's comments, my perspective is a bit different. Here is why:

1. Obesity is a clinical condition. This is why many doctors, psychiatrists and surgeons address it from a clinical perspective (surgery, licensed clinical mental health professionals).

2. I feel passionately that fitness professionals across the board must raise their game as far as learning how to assist their clients to change their behavior is concerned.

The vast majority of fitness professionals (at least in my opinion) have no clue about how to assess stages of readiness as far as adoption of physical activity is concerned.

As fitness professionals, it should be clear to us immediately that when an individual is seeking our services and has expressed or demonstrates that he/she is a habitual non-consumer of fitness and wellness services that it is going to be tremendously difficult for that individual to adopt a new behavior.

This is why it is pivotal that fitness professionals learn how to utilize the transtheoretical stages of change model in addition to the health belief model in order to determine their client's readiness to change as well as the client's commitment towards changing their behavior.

If I might borrow a paragraph from the ACE Personal Trainer Manual:

"Personal trainers spend a great deal of time designing exercise programs and coming up with new and creative ways to target different muscle groups...However, if this is a trainer's sole focus, he or she will have a difficult time establishing a solid client base and helping clients optimal success."

Bryant, as an American Council on Exercise educational partner, I encourage you to find an ACE educational partner in your area and to take the 16-week university level personal trainer course. On this course you will learn how to utilize the health belief model as well as the transtheoretical stages of change model which will teach you strategies to help you help individuals effectively change their behaviors.

I recognize you need that answer now, however, this is not a quick fix. Hopefully, this has given you some direction.

Bryant, I am posting this message here because I believe it will be helpful to the forum.

It is important as fitness professionals that we understand what "self-efficacy."

Self-efficacy is the individual's perception of his or her own ability to be successful with a particular behavior. Self-efficacy is a positively related to motivation.

If a person is not motivated to engage in a particular behavior, we as fitness professionals should hardly expect that that individual be successful in the behavior that we are encouraging them to engage in.

Self-efficacy is closely related to one's past experience with the behavior. If the individual is a chronic non-exerciser, than we would be fooling ourselves as fitness professionals to believe that our clients would be successful in adopting a healthy lifestyle and remain consistent.

As fitness professionals, we must arm ourselves with the necessary skills to assist individuals who are chronically inactive to change.

I encourage all who are ACE certified personal trainers to revisit your manuals and review the chapter dealing with "Basics of Behavior Change and Health Psychology" and those who are not yet certified by the American Council on Exercise as personal trainer to consider taking the 16-week university level course as it absolutely excellent and will give you the knowledge to go about helping individuals adopt a healthy lifestyle with the utilization of behavior change strategies.

this is a delicate situation that requires a lot of diplomacy and the interaction with a therapist.

I can only imagine how much this lady must hate herself; the mirrors in the gym demonstrate to her what a failure (in her view) she is. Please do not judge her as 'disgruntled' and 'not putting in the effort'. Even if you do not say it to her directly, it is your opinion, and she notices it.

If she is willing to come to you in the gym, there is an easy way to deal with mirrors: just stand between her and them. If you can keep her exercising at all, you will have done her a favor. With additional therapy, she may be able to get herself out of what must be a nightmare to her.

" I have a dream that we live in a world where bariatric surgeons embrace the holistic method of treating obesity." This is my new favorite quote. But what does it mean?

It means that the surgeon should explain that there emotional issues at play that caused the energy imbalance that led to the patients obesity. They should explain that no one can stay on a hyper strict calorie reduced diet for the next 20-40 years of their life. They should intoduce the patient to a certified fitness fitness professional who is qualified to work with obese patients before they make the first incision.

In other words, thet should be sure that their patient meets with both a therapist to help deal with the issues that caused the obesity in the first place, as well as that they begin exercising with a professional as soon as medically cleared to do so.

It starts with baby steps but it does not end there. Yes, understanding the TTM and health models is essential, yes understanding exercise design for special populations is essential, understanding nutrition is essential, but most of all is being able to identify with what these people are going through, both before and after.

There is areason that shows like "The Biggest Loser" and Chris Powell's extreme body makeover made it on network TV. They make for great drama-why???

Seek professional counsel. She is stuck in her lifetime learned incapacitiating behaviors and she needs professional emotional support. You can be part of the support system but she is best getting the services of a trained professional therapist. Seek a psychologist trained specifically to help the obese prior to or after lapband.

Make the workouts friendly and doable. Remember self empowerment creates hope. You can make the workouts attainable, creating self confidence and trust in herself and in you.

I know I am late on this convo. However, I have read some good advice here. I am glad I logged in today. I have a client who is depressed and has not made any effort to follow through or follow up. No progress. I decided to have her do mental exercise homework, As I call it. This is where I had her write down (free write) what she thinks is keeping her from reaching her weight loss goals. I discovered through this that she is having difficulty letting go of some unresolved issues. In addition to low self esteem. If I did not have a counseling back ground, I would not have thought to have her do this. I decided to use what I learned to get her re-motivated, if you will. But also, suggested she may want to go see her therapist. Since I am not working with her in that capacity nor is my counseling degree in Mental health but in Secondary (education) Counseling. I used some reality therapy to get her motivated and going again. There is going to be a time she will need to handle her issues before continuing with me or anybody else in regards to fitness.

Hi Bryant. If your client is clinically depressed then the assistance of a mental health professional is probably the only thing that will truly help her. As with a physical ailment, we as trainers should understand our role in the 'wellness continuum' and be prepared to refer out to other healthcare professionals when appropriate. Working in conjunction with this additional professional help, you may be able to help your client make a significant breakthrough.

I think that this situation is a good opportunity to refer to an emotional therapist, meanwhile be okay with just doing some exercises without super high expectations. I mean, exercise just becomes the habit that is positive without expecting major weight loss. Just a thought. Those tough clients always seem to teach me as much as I teach them. Good luck.

Sounds like her obesity is partly due to her depression and she should seek professional help by a therapist. I agree that this should have been addressed before her weight loss surgery. As far as the mirror situation, Do you have the option of training her at home where she may be more comfortable?

I've had it happen a few times where the client thinks they're ready, says they're ready, but then when they feel challenged about 2-3 weeks in, they see progress but they also see how difficult it is to make that progress.

On top of that, when the stress of changing oneself occurs while other extraordinary stressors are present (moving, changing jobs, divorce, etc.), priorities shift and fitness drops in importance.

The only way I've had success in this situation was to encourage the client to therapy, and to ask them to explore their "why" and "readiness" more deeply to see what hurdles are present for them and whether they're ready to leap over. When I have had to have this difficult conversation (not often), about half move forward in a positive direction, and the other half either continue with minimal effort or drop out.